研究背景：台灣山地鄉標準化死亡比最高的死因是農藥中毒。新的事故傷害防制觀念認為，好的防制策略要同時預防非故意性（意外）、故意性（自殺或他殺）或意圖不確定等不同意圖的事故傷害。因此建議要計算合併意圖之事故傷害死亡率統計。可是，在國際疾病分類第八版與第九版中，故意性與意圖不確定中毒事故傷害中沒有列出「農藥」分類項，使得估計合併意圖農藥中毒死亡率有困難。

研究目的：比較意外與合併意圖農藥中毒之死亡率趨勢差異，進一步呈現不同國際疾病分類版本台灣、山地鄉整體、各別山地鄉之死亡率趨勢是否有差異。

研究材料與方法：資料來源為1971至2007年衛生署死因統計資料庫。1971-1980年使用國際疾病分類標準第八版，1981-2007年使用第九版，1987, 1992, 1997, 2002-2007年又以第十版重複註碼。本研究分別計算台灣、山地鄉整體與個別山地鄉之農藥中毒相關年齡標準化死亡率與年齡標準化死亡比之趨勢。

研究結果：台灣1991-1995年意外農藥中毒死亡率為每十萬人口1.85，2001-2005為0.24，下降率為90.1%。但是，以合併意圖農藥中毒年代死亡率則分別為4.88與4.12，下降率為48.6%。山地鄉整體在1991-1995年意外農藥中毒之標準化死亡比為7.30，2001-2005之標準化死亡比為9.85，為上升的趨勢。而合併意圖農藥中毒之標準化死亡比在年代間分別為6.01與4.08，呈現下降的趨勢。而此可知，山地鄉在不同分類列表下計算出的死亡率趨勢也有所不同。使用國際分類第八版與第九版的分析結果與使用第十版分析結果差不多。　

結論：意外農藥中毒死亡率趨勢型態不同於合併意圖農藥中毒死亡率趨勢，造成差異的主要原因是以農藥中毒自殺的死亡率在九十年代後逐漸增加。要更準確估計農藥中毒死亡負擔趨勢，一定要增加合併意圖分類項的分析。

Background: Poisoning by pesticides is cause of death with the highest standardized mortality ratio in aboriginal areas in Taiwan. The new injury prevention concept suggests that an effective injury prevention measure could prevent injuries of all kinds of intents, such as unintentional (accident), intentional (suicide and homicide) and intent undetermined. Therefore, a category
of all-intents-combined should be included in the mortality tabulation list. However, there is no category of “pesticides” in intentional and intent unknown poisoning deaths in ICD-8 and ICD-9, which render the exact estimation of all-intents-combined pesticides deaths.

Objective: To compare the accidental and all-intents-combined pesticides mortality trends by different versions of ICD in Taiwan, aboriginal areas as a whole and individual aboriginal area.

Materials and methods: Cause of deaths mortality data from 1971 through 2007 extracted from Department of Health of Taiwan were used in this study. ICD-8 was used for 1971-1980, ICD-9 was used for 1981-2007 and ICD-10 was used for 1987, 1992, 1997, 2002-2007. I calculated pesticides poisoning standardized death rates (SDR) of Taiwan and the standardized mortality rate ratios (SMR) of aboriginal areas.

Results: The accidental pesticide poisoning SDR in 1991-1995 in Taiwan was 1.85 per 100,000 and decreased to 0.24 in 2001-2005, a 90.1% decrease. However, the all-intents-combined pesticide poisoning SDR was 4.88 and 4.12 in 1991-1995 and 2001-2005, which showed a 48.6% of decrease. The outcome had inferred that these two classification tabulation lists would offer different death trends. The accidental pesticide poisoning SMR in 1991-1995 in aboriginal areas was 7.30 and increased to 9.85 in 2001-2005, which showed an increasing trend. However, the combined-intent pesticide poisoning SMR presented a decreasing trend from 6.01 in 1991-1995 decreased to 4.08 2001-2005. The pattern of mortality trends calculated according to ICD-8 and ICD-9 did not differ very much from those according to ICD-10.

Conclusions: The pattern of mortality trends of accidental pesticides poisoning differed from those of all-intent-combined. The main reason resulted in the difference was the increase of suicide rates using pesticides. To have a better estimation the trends of mortality burden of pesticides poisoning it is needed to calculate the mortality of all-intent-combined.

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